Manejo de la Profilaxis Antitrombótica en el Paciente Sometido a Cirugía Oncológica

Abstract

Venous thromboembolism (VTE) is a preventable and frequent factor (4-7 times higher, compared to the general population) in the surgical treatment of cancer disease. It includes two entities: deep vein thrombosis (DVT) and pulmonary thromboembolism (PE), which contribute to the morbidity and mortality of cancer, these being the second cause of death in this group of patients, preceded only by the same oncological disease.

The association between thrombosis and cancer has been widely studied, thus determining risk factors related to the patient (advanced age and comorbidities), to the cancer itself (certain solid tumors, cancer in advanced stages and distant metastases), and to its treatment (chemotherapy, immobilization associated with major surgery and placement of endovascular devices).

LMWH has been considered the first line of treatment for cancer-associated VTE. However, it has been seen that Edoxaban is non-inferior to Dalteparin, due to the significantly lower recurrence of VTE with Edoxaban, with a higher incidence of bleeding, but better adherence to treatment due to its oral administration. Apixabanproved to be non-inferior to Dalteparin, and without increased risk of major bleeding.

The best treatment is the one that is individualized considering the risk factors of the patient, whether it is outpatient or hospitalized, treatments available in the medical center, adherence to treatment according to the route of administration and duration of the treatment, and the evaluation of the risk of bleeding with the available scales: PESI, Hestia, RIETE, and the patient's wishes.